Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 071.008678 | IL |
N | 103G00000X | Clinical Psychologist | 071008678 | IL |
N | 103TC0700X | Clinical Psychologist | 071008678 | IL |
NPI | 1023419348 |
---|---|
Provider Name | Lisa Annette Conway |
First Address | Chicago, IL 60613-1114 |
Second Address | Chicago, IL 60613-1114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2014 |
Last Update Date | 03/10/2020 |